LOCATION DETAILS PERSONAL DETAILS

Language Known:- Language Read Write Speak Language-1 English Language-2 Hindi Regional Language ... (If yes, give details) Contact I certify that the...

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(Application Form) LOCATION DETAILS State

Applied Location District

PERSONAL DETAILS Name

Father Name

Shop Name

Shop Address

Permanent Address Pin

House :- Own / Rented

State

Disrtrict

Mobile

email

KYC DETAILS

Identity Proof :- Aadhar Card / Pan Card / Driving Licence/ Passport / Voter Card

PAN No

Address Proof :- Aadhar Card / Driving Licence/ Passport / Voter Card

QUALIFICATIONS

Education :- Class - X, XII, Graduate, Post Graduate

Computer Literacy :- Yes / No

If Yes, Nature of qualification

Language Known:-

Language

Read

Language-1

English

Language-2

Hindi

Write

Speak

Regional Language Any Other Lang.

OTHER INFORMATIONS Present Business:-

How many years of experience you have in financial products (if applicable) How many portal are you currently using Do you have any police records? (If yes, give details)

Name:

Address

Contact

Reference 1:Reference 2:I certify that the above information is true to the best of my knowledge and belief.

Signature & Stamp of Merchant

Signature

Full Name

Name of Employee

Date Place

(For Osiris purpose only)